Is intensive glucose control bad for critically ill patients? A systematic review and meta-analysis

摘要

Background: The monitoring and management of blood glucose concentration are standard practices incritical settings as hyperglycaemia has been shown close association with poorer outcomes. Severalmeta-analyses have revealed that intensive glucose control has no benefit in decreasing short-termmortality among critically ill patients, while the studies these meta-analyses have incorporated have beenlargely divergent. We aim to perform a more comprehensive meta-analysis addressing this problem toprovide stronger evidence.Methods: We conducted comprehensive searches for relevant randomized controlled studies in onlinedatabases, including the Cochrane Library, EMBASE, and PubMed databases, up to September 1, 2018.The clinical data, which included all-cause mortality, severe hypoglycemia, need for RRT, infectionresulting in sepsis, ICU mortality, 90-day mortality, 180-day mortality, and hospital and ICU lengths ofstay, were screened and analyzed after data extraction. We applied odds ratios (ORs) to analyzedichotomous outcomes and mean differences for continuous outcomes with a random effects model.Results: A total of 57 RCTs involving a total of 21840 patients were finally included. Patients admitted tothe ICU who underwent intensive glucose control showed significantly reduced all-cause mortality (OR:0.89; 95% CI: 0.80-1.00; P=0.04; I2=32%), reduced infection rate (OR: 0.65, 95% CI: 0.51-0.82, P=0.0002;I2=47%), a lower occurrence of acquired sepsis (OR: 0.80, 95% CI: 0.65-0.99, P=0.04; I2=0%) andshortened length of ICU stay (MD: -0.70, 95% CI: -1.21--0.19, P=0.007, I2=70%) when compared to thesame parameters as those treated with the usual care strategy. However, patients in the intensive glucosecontrol group presented with a significantly higher risk of severe hypoglycemia (OR: 5.63, 95% CI:4.02-7.87, P0.00001; I2=67%).Conclusions: Critically ill patients undergoing intensive glucose control showed significantly reducedall-cause mortality, length of ICU stay and incidence of acquired infection and sepsis compared to thesame parameters in patients treated with the usual care strategy, while the intensive glucose controlstrategy was associated with higher occurrence of severe hypoglycemic events.